CN1688357A - Improved airway device - Google Patents

Abstract

An airway device for human or animal use comprising an airway tube having a distal end and a proximal end, the distal end of which is surrounded by a laryngeal cuff, adapted to fit anatomically over the laryngeal structure of a patient, characterised in that the device further comprises a buccal cavity stabiliser located on or around the airway tube between the laryngeal cuff and the proximal end of the tube, said buccal cavity stabiliser being adapted to nest with the anterior aspect of the patient's tongue, the size, shape and configuration of the buccal stabiliser being adapted to prevent rotational or side-to-side movement of the airway device in use.

Description

Improved breather

Technical field

The present invention relates to a kind of, simple and easy and multi-functional modified model breather suitable mutually with anatomical structure.Described modified model breather is particularly useful as, but is not limited to, in surgical operation to the device of patient's administration of anaesthetic that can autonomous respiration.The invention particularly relates to a kind of laryngeal airway devices.More specifically, the present invention relates to a kind ofly reduce expense, disposable laryngeal airway devices, and relate to the method for making this type of breather.

Background technology

The airway of a kind of cleaning and non-hand-held is provided, being used in the example of patient's device on one's body of acceptance anesthesia that can autonomous respiration at present, following (wherein said patient is for being in anesthesia afterwards between convalescent period, be in Intensive Care Therapy some patient of confinement period, perhaps be in during the recovery):

A) have the Guedel breather of various masks;

B) capsule formula oropharynx breather;

C) throat's bell-type breather (LMA), enhancement mode LMA, cannula type LMA and be used in the Intavent modified model LMA of ENT (department of otorhinolaryngology);

D) inducing QI control device

E) combined catheter

F) self-hard nasopharynx breather

G) capsule formula or non-capsule formula endotracheal tube, R.A.E. endotracheal tube;

H) supraglottic region oropharynx breather (Supraglottic oropharyngealairway);

I) tracheotomy and tracheole;

J) other

The use of all said apparatus all can be obviously and is caused that to some extent concurrent pathological changes, described pathological changes comprise that not only the physiological of unacceptable synchronous generation changes but also comprises damage on the temporary and/or nonvolatil anatomical structure.Directly cause dead many examples that report has been arranged by the use of described device.

The most successful variation of design aspect should be the expansion type laryngeal airway devices, and some of described expansion type laryngeal airway devices improved type and be used in infusion anesthetic gases aspect from 1988.

The Development History of relevant this kind breather is described in one piece of paper that AIJBrain shows, and this paper publishes in the 5th to 17 (the containing) of " European anesthesiology periodical (the European Journal ofAesthesiology) " supplementary issue 4 in 1991 page or leaf.The full content of this paper is incorporated among the present invention by reference in this, and constitutes the part of invention.

If respiratory trees is regarded as the conduit that ends at glottis, as and if purpose then forms a direct end-to-end connecting device and meets logic at described conduit with under low pressure supply a gas to and set up easy a connection between the artificial conduit on the bronchial tree between these two kinds of conduits.The mask formula can form a kind of end-to-end connecting device really, and its aperture is improper, and is too dark but it inserts in vestibule although gas inner catheter and correct aperture join, thereby described connection is by connecting in the hole in fact, rather than by the orifice edge realization.The unfavorable aspect of endotracheal intubation can be found out from this fact: in order to realize sealing, pressure is applied on the epithelial surface, this will influence its important and unique function; In addition, owing to penetrate into the vocal cords position, the cough of Yin Faing will be difficult to tackle thus, can cause the torsional deformation of airway superstructure, simultaneously needing the laryngoscopy of carrying out before the intubate and being present in endotracheal tube in the trachea all will stimulate and make patient produce undesired reflex response.This type of laryngeal mask tool just was used for anesthesia procedure from 1988, the existing concurrent pathological changes directly or indirectly relevant with the use of this type of laryngeal mask tool and/or many reports of pathological changes.Complication and/or pathological changes are that the pressure owing to excessive expansion and capsule inner chamber is pressed on the softish tissue that contacts with excessive expansion formula capsule and the cartilage structure and causes.

Repeatedly attempt this type of breather is improved, but still have some serious self inherent shortcomings.At first, capsule need be inflated to significant degree, anesthetic gases (laughing gas) can be diffused in the capsule thus, thereby increase the chamber pressure of capsule significantly, and then the throat tissue of rapid wear will bear sizable pressure.Secondly, when the close end of the conduit that is connected to anesthesia equipment was stressed, these cover tools were easy to shifted laterally or rotate around its longitudinal axis.If should be understood that in use this type of device placed fully symmetrically that then airway will be aimed at patient's nose.Yet any rotation of airway or lateral movement all might have influence on breather formed sealing around atrium of larynx.

Describe in the patent documentation some kinds of breathers are arranged.For example, United States Patent (USP) (US5,976,072, Johns Hopkins university) has been described a kind of optical fiber endotracheal intubation device.Yet this device is based on expansion type oropharynx capsule, and it has aforesaid shortcoming.

United States Patent (USP) (US5,865, O ' Neil) and British patent (GB2 176,, 319,182, VBM Medizintechnik Gmbh) described the breather with the configuration of two expansion type capsules, the first expansion type capsule is used to form the pharyngeal sealing of patient and the second expansion type capsule is used to form the sealing at patient's esophagus position.This configuring weighted problem of aforesaid tissue injury.

British patent (GB2,373,88, Smiths Group plc) has been described the configuration of a comparative, and promptly a kind of expansion type laryngeal mask tool has a catch that is designed to prevent to cover the breach shape that tool hinders mutually with epiglottis during insertion.But this only is to have emphasized that this type of expansion type tubular cover tool has the function of inserting the people downwards.

At last, in international monopoly (WO00/61213, Brain), a kind of disposable, throat's bell-type breather of having an expansion type capsule has been described.Yet this kind device not only has whole shortcomings that the expansion type bag apparatus is had, and owing to be made of a plurality of parts, has increased cost and the complexity made.

All these patents are the most relevant prior art known to the applicant.

One object of the present invention is part or all that capture or alleviate these problems.

Summary of the invention

First aspect of the present invention is for providing a kind of breather.

Correspondingly, according to first embodiment, a kind of human and animal's of being used for breather is provided, described breather comprises an airway with a distal portion and a close end, the distal portion of described airway is around a laryngeal cuff, described laryngeal cuff is suitable for forming at patient's atrium of larynx position the sealing of an anatomical fit, it is characterized in that described device further comprises a buccal space fixture, above the airway of described buccal space fixture between laryngeal cuff and catheter proximal end portion or on every side, and described buccal space fixture is suitable for patient's tongue front portion suitable, its size, shape, pliability and profile are suitable for providing stability and can prevent airway rotation or shifted laterally in use.This buccal space fixture can be by making with the identical or different material of capsule, and it helps described device placement and location in use.

To be called NLA (Nasir laryngeal airway devices) hereinafter for short according to breather of the present invention, this is called for short the naming with the inventor.

Preferably, capsule is unexpansive formula, and makes a shape in advance, and described shape is suitable for forming connecting airtight of anatomical fit on the structure of patient throat.Pleat and pears shape nest place make the atrium of larynx position have irregular anatomical structure between Wood-scoop epiglottis pleat, Wood-scoop shape and corniculate cartilage, arytenoid cartilage.Term " atrium of larynx position ", " atrium of larynx framework " and " atrium of larynx structure " are used interchangeably in following description.These terms relate to patient's atrium of larynx position and surrounding tissue, pleat and cartilage, as shown in Figure 1.

The shape profile of this device and the knot of tissue of throat constitute complementary, thereby can form connecting airtight of anatomical fit with the irregular structure in throat.Simultaneously, compare with the situation of using the expansion type capsule, the device that has the cup/capsule of its design anatomical fit also has advantage, and described expansion type capsule will produce a sizable chamber pressure, fully greater than the 22-26mm mercury column.Under this pressure,, will make the organization of human body that contacts with capsule produce torsional deformation, pressurized, displacement, misplace or break although described capsule has softish body structure surface.The capsule sealing of inflation to obtain suiting repeatedly, but also will make the structures surrounding torsional deformation by the formed undue influence of capsule circle, surface smoothing, that tighten simultaneously, described capsule inflation repeatedly is to cause the bottleneck throat structure to bear the reason of chamber pressure, and the inner chamber that described chamber pressure also can be in capsule uses be sucked into capsule owing to laughing gas (anesthetic gases) increases.This will make bag pressure power increase to the mercury column above 100mm rapidly, use in one hour, and pressure can be raised to the mercury column above 200mm, and this pressure surpasses the ICP power of capillary blood supply bottleneck throat structure fully.

Preferably, laryngeal cuff is molding in advance, inflation or be pre-charged with suitable fluid in advance.

Preferably, be suitable on patient's laryngeal structure forming the laryngeal cuff face that connects airtight of an anatomical fit feature, have and be designed to the bellying that can form good sealing with pears shape nest place in patient's laryngeal framework and Wood-scoop epiglottis pleat.Simultaneously preferably, the face of candidate capsule also has and is designed to and can forms good sealing with Sublingual small stream portion (Sublingual ditch valleculae), epiglottis, Wood-scoop epiglottis pleat, pears shape nest place, and can form the bellying of excellent sealing around the front portion of first shape and cricoid cartilage.Around the sealing at these positions, can be strengthened and improved by one or more featheriness flange on the part or all of periphery of laryngeal cuff.The sealing load that obtains to increase is guaranteed in this design, promptly can surpass the 30cm water column fully.

In a further advantageous embodiment, be suitable for forming the surface be close to the laryngeal cuff of connecting airtight with patient's atrium of larynx position and have groove, described groove design becomes can guarantee to supply the important tremulous pulse, vein of laryngeal structure and neural unobstructed.

In a particularly preferred embodiment, the far away vertical size and dimension of throat's cup-shaped cover be suitable in use making its remain on sphincter of gullet above.The most preferably, the far away vertical spill substantially that is shaped as of throat's cup-shaped cover.

In an alternative embodiment, throat's cup part is made by a kind of material that is suitable for absorbing liquid (such as water/mucus/blood or similar substance) in advance, thereby cause that described throat cup-shaped cover parts expand, and then suitable with the dissection of atrium of larynx mucosa cartilage (mucocartilagenous), described material for example is used for making the CRM (cotton and staple fibre blending) of TRMPAX (registrar entitling) tampon or compression Gel Foam5 (gluey foam).

Preferably, the buccal space fixture has one first, is the outside of belly, its substantially with the opening surface of the laryngeal cuff plane that exists together, and first of described buccal space fixture be shaped as spill substantially.This helps operator will install the insertion patient and the buccal space fixture is contacted with patient's tongue.

Preferably, the close end of buccal space fixture from the close end of laryngeal cuff towards airway extends the structure thereby capsule and buccal space fixture become one.This just provides a kind of level and smooth and exquisite device, has attractive and practical design pattern.

Preferably, the width W of buccal space fixture is inconsistent, among the close end of laryngeal cuff and airway, have a width point, and more preferably, the close end of close more laryngeal cuff of the width point of described buccal space fixture rather than close more airway.This tongue bottom that is arranged so that described fixture in use can the wideest zone be placed on patient is gone up and is contacted with it.

Preferably, the width W of buccal space fixture is 2.7 ± 10% at the ratio of height H of its wideest some place and the buccal space fixture that is in same point.

Advantageously, the buccal space fixture can be matsurface with the face that patient's tongue contacts, with the friction of increase in use with tongue.

In another alternative embodiment, the size adjustable of buccal space fixture is whole, and for example buccal space fixture wherein is made into parts, and at least a portion of described parts is contained on the airway with form slidably.

In a particularly preferred embodiment, the buccal space fixture is made an ingredient of airway, further preferably, buccal space fixture, airway and laryngeal cuff are made one.

The Shore hardness of each part, ingredient or parts is key characters of the present invention.For example, preferably, laryngeal cuff is equal to or less than 40 material by Shore A hardness and makes, and is more preferably 0 to 20, is preferably 4 to 12 the most.

Preferably, the forward part of laryngeal cuff and buccal space fixture, be outside of belly part by Shore hardness substantially identical materials make.This makes structure summary, and has guaranteed that all sites of the described device that contacts with patient's parenchima is all soft.

In another preferred embodiment, the back part of device or be back part and the forepiece of device or make outside of belly parts make by the different material of Shore hardness.This has guaranteed that back part can be made by the material more solid than outside of belly parts.

Preferably, back part or back part are made less than 60 material by Shore A hardness, are more preferably between 25 to 45, are preferably between 30 to 40 the most.

Should be appreciated that simultaneously laryngeal cuff can be expansion type.Although this is unsatisfactory, with respect to the expansion type cover tool of prior art, it has still represented tangible progress.

Preferably, described device can further comprise a gastric tube passageway, and it extends to the close end of said apparatus from the outstanding top of capsule.

According to second aspect of the present invention, a kind of method of making breather is provided, comprise following steps:

(a) make first parts of described device and the moulded parts of second parts;

(b) by connector first parts and second parts are connected together.

With respect to the manufacture method of prior art, it is usually designed to a plurality of parts, seems quite simple according to manufacture method of the present invention.

Preferably, first parts be device forepiece, be outside of belly parts, it includes the surface of laryngeal cuff, and second parts are back part, are back part, wherein first and second parts are made by the identical or different material of Shore hardness.

According to the 3rd aspect of the present invention, provide a kind of manufacturing to include the method for the breather of an airway, a laryngeal cuff and a buccal space fixture, described method is made the plastic mould that connects together with described device, and preferably wherein said device is made with injection moulding.

Description of drawings

Description, and only present invention is described by example, and wherein said accompanying drawing is as follows:

Accompanying drawing 1A has shown the different views of throat's cartilage and ligament to C.This diagram is selected from Tortora G.J., Grabowski G and Reynolds S.'s " anatomy and physiology " (John Wiley, 2003 the 10th volume the 781st page).In this content and diagram of having quoted this article by reference;

Accompanying drawing 2 and 3 has shown the plane graph of two embodiment of the present invention;

Accompanying drawing 4 to 7 is the part exploded view of two other embodiment, and each breather is shown as two parts, be clipped in therebetween be an airway;

Accompanying drawing 8 has shown the alternative features of second channel or duct, and described second channel or duct start from the side position of NLA close end, and towards the distal portion bending extension, thereby its opening far away is positioned at the back part of NLA conduit, and penetrates in the cover tool, and then can insert stomach tube;

Accompanying drawing 9 has shown a longitudinal crack, and it extends along the length direction of cover tool substantially, can hold endotracheal tube, is used in the expectation or the outer situation that has difficult intubation of expectation, and be with or without bougie, Cook ' s airway or optical fiber sight glass and all can this moment;

Accompanying drawing 10.1 to 10.6 has shown a plurality of plane graphs, side view and the sectional view of another embodiment of the present invention;

Accompanying drawing 11,12 and 13 has shown that wherein the size adjustable of buccal space fixture is whole according to two front views of an alternative embodiment of the invention and side view or side view;

Accompanying drawing 14 roughly shown be bonded on the atrium of larynx position, according to breather of the present invention;

Accompanying drawing 15 (deleting);

Accompanying drawing 16 is some perspective views, cross-sectional view and the part exploded view of breather, has shown that airway himself can expose on described device main body;

Accompanying drawing 17A has shown forward sight, backsight, the side-looking of another preferred embodiment of the present invention and has looked closely elevation to F;

Accompanying drawing 18A, B and C have shown the forward sight and the side elevation view of special preferred embodiment, and it has extend, the thin and flexible flange in a part of edge around laryngeal cuff;

Accompanying drawing 19,20 and 21 shown according to of the present invention, be used in the schematic horizontal surface chart and the isometric view of patient device on one's body;

Accompanying drawing 22 has shown the tangent plane along as shown in Figure 21 line Y-Y.

The specific embodiment

Below only the specific embodiment of the present invention is described by example.Although these examples are not the only embodiments of the present invention, it has been represented and has implemented best mode of the present invention, is the present embodiment of grasping of applicant.

Accompanying drawing 2 has shown the distal portion (distal end) according to the cover tool device (maskdevice) of first embodiment of the invention, is designated as 10 usually.Described cover tool device comprises an airway 11, and described airway 11 ends at the 15mm connector that is positioned on described cover tool device close end 12 (not shown)s or other and is suitable for the connector place that is connected with the air suction type anesthesiaing system (an anaesthetic breathing system) of general type.Laryngeal cuff or cup 14 are formed at around the distal portion 13 of airway, and its shape and profile are suitable for matching with patient's atrium of larynx position.Under this prerequisite, term " capsule " has identical implication with " cup ".The parts that it all refers to described device are positioned at the distal portion of airway, be suitable for covering patient atrium of larynx, and form sealing.In this manual, term " near-end " refers near the end of the described device of air suction type anesthesiaing system connector or the part of described device.Term " far-end " refers to from the end of described air suction type anesthesiaing system described device farthest or the part of described device.

Usually, the expert is quite familiar to laryngeal cuff, in accompanying drawing 1A, B and C, than the anatomical structure that has shown human atrium of larynx position in more detail.Special capsule shown in the accompanying drawing 2 has tangible protuberance or bellying 15,16 on its face, it is designed to and can goes up the good sealing of formation at pears shape nest place and Wood-scoop epiglottis pleat (aryepiglottic folds).Should be able to find out be designated as 15 and 16 capsule be placed in the preceding outside (ANTERO-LATERALLY) to the outside bulge, be suitable for putting into described pears shape nest place and Wood-scoop epiglottis pleat, thereby have the sealing function on the anatomical structure.Thereby from side view, the face of capsule is not a concordant plane, but contains the part that bloats from the residing principal plane of the face of capsule.The part that also can include in addition, the below of the residing principal plane of face that is positioned at capsule.The surface configuration of the capsule face around the opening 17 and overall size and profile and profile are the important feature of the present invention.Other shapes that in accompanying drawing 3,5,10,11,12,17 and 18, shown the face of capsule, and following described in more detail.

This device can be selected by process material expert, any suitable plastic material is made.(Latex-free) medical grade silicone that does not contain latex is a kind of preferable material.Capsule should the quality softness to avoid that surrounding tissue is caused damage improperly.Other suitable materials of making this type of device comprise, but be not limited to, polyvinyl chloride (PVC), thermoplastic elastomer (TPE) are (such as styrene block copolymer, as s-B-S (SBS), styrene-ethylene-butylene-styrene (SEBS)) and the whole copolymer (PEBAX) of thermoplastic polyolefin-like mixture (TPO), thermoplastic polyurethane (TPU), copolyesters (COPE), polyester and polyamide, and form of foam (as suitable).

Another key factor that relates to the suitable material selection is a transparency.Ideally, making one or more used material should be limpid substantially or transparent.This just guarantees that anaesthetist or operator can see the inner chamber of airway, stops up or other problems so that check.The material expert is familiar with this kind transparent material.

In a preferred embodiment, capsule is unexpansive formula, and is made by any suitable flexible plastics material.For preferred pliability (hardness) scope, be benchmark with the Shore A hardness, the optimum hardness of the face of the capsule of contact atrium of larynx should be less than 40.And for this preferable range, according to identical standard, preferred hardness number is between 0 to 20, and wherein particularly preferred scope is 4 to 12.Can further improve the pliability (shown in attached Figure 4 and 5) of capsule by among the main body of capsule self, making cavity or duct.

In a further advantageous embodiment, capsule can be pre-charged with fluid, such as air or other non-toxic gas or non-toxic aq.Under this prerequisite, term " fluid " has connotation widely, and it comprises any suitable gas, liquid, steam and compositions thereof, and is determined together with the material expert and designed by the expert in anatomy anesthesiology field.Capsule will be made by so a kind of material, and described material makes laughing gas (anesthetic gases) not spread from this material with significant quantity, thereby the chamber of (extra) that add pressure is kept constant.Therefore, it has met this requirement, promptly for the liquid of filling in it, and anesthetic gases, capsule should have anti-permeability substantially.

In addition, capsule can be made by softish foamed materials, maybe can insert foamed materials.Both of these case all can obtain a softness, deformable and figurate surface around the face of capsule, on the anatomical structure that can be bonded on the atrium of larynx position.The device of this kind filled and process will make the latent injury of this position organizational structure reduce to minimum, still have good sealing property substantially simultaneously.

Next-door neighbour's laryngeal cuff/cup, and be positioned at close capsule airway one end be a buccal space fixture (stabiliser) 20.In this example, the pattern that this fixture adopted is: the excrescence that stretches out in the airway lateral symmetry.This fixture is suitable for being placed on the proparea or the front portion of tongue, and the anatomical structure at its shape and this position of patient matches.

The shape of fixture, size and residing position can have multiple variation.The face of accompanying drawing 2 described fixtures is with respect to the residing planar curved surface of the face of capsule, and the face of the fixture of being seen in the accompanying drawing 2 then protrudes a little for recessed a little curved surface, its back side.The face of fixture can be coarse, band cut or band tooth, with increase and tongue between friction, thereby in use can be fixed, avoid or reduce moving forward and backward in the use.

In this example, fixture and capsule are made one, thereby one of them can insert another smoothly.Yet, this not necessarily, fixture can be used as on the airway independently parts.The width that an inner characteristic of this fixture is its cross section is greater than the diameter of airway self.That is to say that a part is respectively extended in its both sides at airway, and is on the principal plane identical with laryngeal cuff.This buccal space fixture preferred sizes will be in following argumentation.

Another example of the buccal space fixture of different designs is presented in accompanying drawing 11,12 and 13.In this example, fixture 50 can be adjusted, and has two side hooks 51,52 in both sides, close end near airway, it can slide up and down increasing or to reduce the size of flange (flanges), playing suitable Stabilization, and is easy to the insertion of NLA and extracts.Described hook and ratchet bar (ratchet strips) 53,54 interlocks, described ratchet bar 53,54 is formed at the relative both sides of breather.Described fixture by distortion very easily, flexible material makes, thereby hook is being shifted onto one when being positioned at the position of the capsule in the distal end of catheter portion (as shown in Figure 12) more from position as shown in Figure 11, along with hook is shifted to capsule more, then fixture is wide more in the extension of airway both sides for fixture.Thereby this fixture can extend to the close end of laryngeal cuff from the close end of the airway below the connector.The shape of described fixture is symmetry substantially, and can be toward lower slider, transversely to obtain the shape that extends in the buccal space.Accompanying drawing 13 has shown the oblique side view of this embodiment.

This only is to can be used for making a kind of in many methods of fixture.Fixture can by any (being preferably softish) around airway wall, can lean against the forward plane of flattening of tongue and form.Any have suitable shape, that extend laterally, its main body and mainly all can play this effect along the flange that the longitudinal axis of airway extends.Described flange is not necessarily solid, thereby tubulose, netted or other porose structures all are feasible.Preferably, along as shown in Figure 11 direction, promptly when the normal direction of the face of capsule was seen, described fixture had concave surface or recess, and described concave surface or recess and patient's tongue front portion are suitable substantially.

Also can be by position suitable above capsule, widen the profile of breather and form one " flange ".That is to say that the buccal space fixture can be an ingredient of airway, rather than an individual components that is formed at or is looped around on the breather.Thereby a suitable augmenting portion on the airway main outline no matter it is formed by conduit self or makes by the extra material that adds at airway, all can be used as a fixture on every side.

The general profile that can in accompanying drawing 16,17A and B, at length see the buccal space fixture with and smoothly with the bonded mode of capsule, and will describe in further detail following.Yet will be understood that if the internal diameter of airway or in-profile correspondingly increase and decrease along with the wide variety of buccal space fixture, can reduce the use of weight and minimizing plastic material.Adopted term " in-profile " in this, reason is that it becomes non-circular when airway is widened, and presents an oval substantially shape.Should be appreciated that thus that in this embodiment be increased in the process of its wideest point at the width of buccal space fixture, the cross-sectional area of airway increases earlier, then reduces again.By the width of maximization airway, can add the laminar flow in the bigger device.

Another of breather shown in the accompanying drawing 11 is characterized as: have two groups of bellyings or protuberance 56,57 and 58,59 on the face of capsule.In these two groups bigger one group 56,57 be suitable for around Wood-scoop epiglottis pleat and be put in the pears shape nest place.Less one group 58,59 in two groups are suitable for around thyroid cartilage and cricoid cartilage.In addition, the top 55 of capsule is softish taper protuberance, and preferably, described top 55 is unexpansive formula.

Another example is presented in the accompanying drawing 3.Accompanying drawing 3 has shown breather 30, has a capsule 34 and a buccal space fixture 40.In this example, the both sides of capsule have two groups of protuberances or bellying 35,36 and 38,39.One group top (38,39) comprise two bellyings of one of a side, are designed to be placed on Wood-scoop epiglottis pleat and pears shape nest place.Following one group (35,36) are designed to place thyroid cartilage and cricoid cartilage.The relative size of these protuberances is determined by suitable expert.Be designed to be placed on the protuberance 38 and 39 in Wood-scoop epiglottis pleat and the pears shape nest place, generally speaking less times greater than two following protuberances.Far away/lower the end of capsule is soft but firmly, and preferably, does not need to expand in advance or be pre-charged with, with the insertion that is easy to device and be suitable for being placed between throat and the esophagus.In accompanying drawing 4 to 7, show its further variation, shown the motor-driven adaptability that it had under this total design concept.Accompanying drawing 6 and 7 has shown the situation that can include an extra moulded parts 60 on the close end of this device.

Accompanying drawing 5 has shown a kind of feasible manufacture method according to device of the present invention.This device is made two parts 81 and 82 by aforesaid appropriate materials.Described two parts are connected together around airway 83 (it is succinctly clear that demonstration makes accompanying drawing).Airway is suitable for putting into specially designed duct 84.In this example, buccal space fixture 90 is molded as one with capsule 94.The top of this device includes a series of or several holes 91,92 and 93.In this article, " several (plurality) " refers to one or more.These holes have increased described vertical pliability, and it helps the insertion and the location of device in use.These holes also have influence on vertical pliability and pliability (pliability), and the existence of these holes makes described top more soft with respect to the top of being made by the solid plastic material.Usually, the soft more then probability to the tissue of patient damage of material is more little.From attached Figure 4 and 5, also can see this device indent characteristic generally significantly.

In these embodiments, another feature that can obviously find out from these accompanying drawings is that the top far away of described device is tapered into a mild tapering point.This tapered end will be placed on or wedge between throat and the esophagus inlet.

Can from accompanying drawing 4 to 7 (containing), find out and understand a kind of method of making according to breather of the present invention.Basically the device in the accompanying drawing 7 is made up of two parts 61 and 62, adds a moulded parts 64, and described moulded parts 64 comprises connector or other connectors of a 15mm, to attach the device on the air suction type anesthesiaing system.Be designated as 61 be the moulded parts outside of belly or preceding moulded parts, i.e. the part that contacts with tongue with patient's atrium of larynx.Be designated as 62 be the moulded parts back side or back moulded parts, promptly face is from the other side of outside of belly part.These terms, i.e. " outside of belly " and " back side " will be in this description.

Alternatively, described device also can comprise an independently airway 63, is placed in the duct 66,67 on the endosome that is formed at moulded parts 62 and 61 respectively.Yet, in a particularly preferred embodiment, do not need described individual conduits 63.In this embodiment, conduit 63, moulded parts 62 and 61 are made by silica gel, and moulded parts 64 and 68 is then made by polypropylene.In two polypropylene moulded parts bigger one (68) (not having mark among the figure) be designed to prevent described device too far (beyond a certain point) enter into patient's oral cavity.

Airway can have any suitable diameter or cross section (is not circular as this conduit).Be generally used in the described breather adult model is the conduit of 9mm.

In assembling process, moulded parts is 61 and 62 bonding, gummed, welding (including but not limited to thermal weld and laser weld) or be fixed together with additive method. Moulded parts 61 and 62 can be made by the material with different hardness, adopts above-mentioned simple, exquisiteness again and low cost method is fixed together.Thereby the forepiece (61) that comprises laryngeal cuff can be by making than the softish material of back part.Usually, the Shore A hardness of forepiece 61 is more preferably 0 to 15, further is preferably 4 to 12 between 0 to 20.

Usually the Shore hardnes figure of back part 62 is 20 to 60, more is preferably 30 to 40.

Also an additional channels 70 or several passages can be incorporated in this device main body, described passage also comes the next door of airway.An example of relevant this respect is presented in the accompanying drawing 8.During use, this passage is feasible can be inserted into other conduits or lead in the esophagus, and does not need described device is removed or interfered with to described device.For example, a mouthful gastric intubation method (orogastric intubation) has become possibility now.

As shown in Figure 9, in another changed, breather combined a crack longitudinally, and it extends along the whole length direction of passage substantially.This just makes can or extract out other conduits or lead (bougie, probe) insertion during use, and can not interfere with the cover tool.In addition, this crack is provided with and also means and breather can be separated from other conduits and lead, and can under other conduits of maintenance or the impregnable in position situation of lead described breather be taken away on one's body from patient.

Accompanying drawing 10 has shown an alternative embodiment of the invention, and has shown the curve shape of described device on its y direction.The patient's that this shape is designed to and accepts to anaesthetize oral cavity and throat tract are suitable.The described longitudinal axis is the axis shown in the accompanying drawing 10.4, i.e. straight dotted line in the accompanying drawing, and its close end from airway extends to the top far away of capsule.

The general shape that in accompanying drawing 10.3, has shown a preferred embodiment of buccal space fixture.Usually will be designated as 100 described fixture makes around airway 101.Yet, as mentioned above, not necessarily need an independently conduit, also can constitute a piped passage by the duct that is formed within the mount body.The part 102,103 of fixture is stretched out in the both sides of conduit 101, forms a plurality of stepped serrations substantially.From accompanying drawing 10.1 and 10.5 and accompanying drawing 17 and 18 can find out that the width of buccal space fixture is inconsistent, but change along its length direction.The airway of similar device has formed contrast in this and the prior art, and described its cross section of prior art airway is consistent substantially.In this article, described width refers to the size between the both sides, is that benchmark calculates with y direction and the opening surface that is parallel to a capsule substantially planar plane of living in perpendicular to this device promptly.The width of described fixture is the narrowest at the close end of this device, and then its width is increased to maximum, and its width reduces again then, joins up to the nearside with laryngeal cuff.Therefore, its maximum width at of fixture is between the close end of the close end of airway and laryngeal mask tool.Generally speaking, if the width largest portion shown in accompanying drawing 17A and B, then can be an advantage point more near an end of laryngeal mask tool rather than the close end of more close device.In use, this just makes the Breadth Maximum part can the most closely be positioned at patient's tongue front portion.

Crucial a bit is that the height H of fixture does not change in an identical manner, but keeps identical substantially along its y direction.This point is different from traditional airway fully.

Obviously find out that according to aforementioned oval width W at the widest part is greater than the height H that exists together mutually.For example, for use breather according to adult of the present invention, fixture will be at 3.5cm among the scope of 4.5cm in the width W of its widest part, and height H will be among 1.25cm arrives the scope of 1.75cm.The preferred ratio of W/H is 2.7 ± 10%.

A key character of the shape of described fixture is the profile of its outer surface of upper 104 and lower external face 105.These two outer surfaces are convex, and are level and smooth curved surface at its widest part.This point not only makes it be easy to use, and the more important thing is, the lower surface 105 that in use contacts with tongue, the shape at its profile and patient's tongue body rear portion is suitable, and lower surface 105 is enough soft, deformable and matching with the shape at patient's tongue body rear portion.

In accompanying drawing 16, shown another embodiment.In this embodiment, airway 111 only partly wraps in the main body of breather 110.The distal portion of conduit penetrates, and passes completely through the main body of breather 110, thereby forms an opening 113 in capsule.In this embodiment, show one and had differently contoured fixture.In this embodiment, the lower surface 115 that in use contacts with tongue, it is shaped as level and smooth spill, and simultaneously upper face is convex substantially.

In case link together, in fact described device can become as a whole structure.That is to say that each parts have constituted one.If described device is reusable, this will make the sterilizing operation summary, and increase its reliability.

Yet, not necessarily must Construction integration.For example,, also the buccal space fixture can be made an independently parts (not shown) as needs, again with described independently buccal space fixture cover (threaded) above airway, on every side or above.This design makes the anaesthetist can select usefulness as required when using described device or without fixture.Certainly also need to adopt certain fastening means that fixture is fastened on capsule or the conduit.Mode fixing or fastening plastic components is well-known, such as button (snap-fit) connector.

This selection has increased the alternative of anchor designs aspect.Can adopt the form of the spring leaf that is fastened on the airway one or both ends.In addition, also can use the expansion type structure.Expansion type capsule as previously described.Up to now, this technology also never is used for fixture between a cheek is attached on this type of device.

Accompanying drawing 17 and 18 has shown two other embodiment.Shown in the accompanying drawing that wherein capsule part 121 is joined with buccal space fixture part 122 smoothly according to the structure of fairshaped, the one of these embodiment of the present invention.In these accompanying drawings, shown the feature of some other key.For example, when airway entered into laryngeal cuff, it had connected three independent apertures 123,124 and 125.This will greatly reduce the airway possibility of jamming.The shape of the distal portion of the fixture that is connected with the close end of capsule/cup, design by this way: described device in use, on anatomical structure, the distal portion of described fixture can be placed on rightly Sublingual small stream portion (Sublingual ditch, epiglottic vallecula) (valecullae) among and on every side.

The top far away 126 of capsule has been done excision and has been handled, and is spill in fact now.This makes the blood vessel and the supraneural pressure ratio that are applied to first shape and cricoid cartilage and the supply of responsible laryngeal structure use the situation of prior-art devices little.Multiple different shape and pattern can be adopted in this so-called spill top.Described top can " truncation ", thereby this vertical end is straight substantially.Or the top shown in accompanying drawing 17A has significantly recessed.In recessed bottom is the aperture of the end of a formation gastric tube passageway as described below.Generally speaking, this excision is handled and is comprised any top that can reduce institute's applied pressure with respect to one type of prior art syringe.

The one and another gastric tube passageway that is independent of airway is provided, and near the opening 127 of its described device close end connector 128 extends to capsule vertical opening 129 far away (more clearly illustrating in accompanying drawing 17E).Gastric juice is counter to flow under the situation of (passiveregurgitation) occurring between the operating period, can detect any stomach aspirate by described stomach tube.This also provides an approach that inserts small-bore stomach tube (Freka conduit).

This installs another novel features is outstanding top or the flange 130 that is positioned at capsule segment proximal portion.But described outstanding vertical size and dimension places on the epiglottic cartilage with making its anatomical fit, thereby guarantees to have suitable sealing, and pulls back the epiglottis cartilage is past, in order to avoid epiglottic cartilage is pushed down atrium of larynx forward, thereby has avoided the obstruction of air-flow.Foliated structure has been adopted on this top, and the close end direction from laryngeal cuff towards airway is stretched out.Can from accompanying drawing 17, see the size and dimension that it is relative.Best size and dimension will be determined by experiment.The applicant has never seen any cover tool with prior art of this feature.

Accompanying drawing 18 has also shown some novel features of structure aspect and laryngeal cuff.At first see capsule, in this embodiment, adopted thin flexible flanges 140 and 141 in the relative both sides of capsule.Preferably, these flanges are made an ingredient of capsule moulded parts, and because it is soft in the extreme to be used for making the material of capsule, these flanges are soft and pliable and tough extraordinarily.The effect of described flange is the difference that allows any different patient's atrium of larynx shapes, and helps to form between capsule and laryngeal structure a sealing efficiently.Be designed to have close suitability on anatomical structure by such design and with described capsule, the sealing load that obtains from experiment can surpass the 30cm water column fully.

At the featheriness flange 140 shown in the accompanying drawing 18 and 141 is discontinuous construction, but in fact they can interconnect (as accompanying drawing 18C and D) in the distal portion of capsule.In such design, flange 140 and 141 becomes the U-shaped flange of an one, around most of edge of laryngeal cuff.

The structure that in accompanying drawing 18, has also shown a disome formula.Two parts are the parts 145 of a upper bend, and its outer surface is the cardinal principle convex, and the parts 146 of a lower knuckle, and its outer surface is the cardinal principle spill, and described lower member 146 includes the face of the laryngeal cuff that in use contacts with patient's atrium of larynx.Be formed with an airway duct among these two parts, it extends to distal portion or capsule 149 from close end 147, also is formed with aforesaid second channel.

By using a kind of adhesive suitable, that select by the material expert or, using connector 150 to link together upper member by welding method.

Advantageously, upper member 145 is made by the material with different Shore hardness with lower member.Thereby upper member can be made by the material of Shore A hardness in 30 to 40 scopes, and lower member can be made by softer, the material of hardness (same rigidity level) in 4 to 12 scopes.

As needs, the capsule parts can be had the different materials of different hardness by the miscellaneous part with device and make.Such design is presented among the accompanying drawing 17C, and device described in the figure is made up of three parts 135,136 and 137, rather than two parts.

Yet the exquisite and simple design of this breather makes manufacture method more simple really.Found that described device can be molded as the single tectosome of an one in a mould.By making mould rightly, and fully take into account and how mould part is separated, then the integral type manufacturing is possible.Double injection molding method known to can using is usually made moulded parts, and material is injected respectively to make the relevant portion of parts therebetween.In addition, also can use the single injection method all the time, parts can be made by the hardness identical materials, as hope, then cover molding at all or part of position at the outside of belly or the back side, and the different material of Shore hardness can be adopted in the described outside of belly or position, the back side.The technology of this covering or stratiform product of making is known for those skilled in the art.

Now forward the design aspect of laryngeal cuff to, in above-mentioned example, the capsule part is made by softish material in advance, or inserts a kind of fluid in advance in manufacture process.In the later case, the lining of capsule should be made by a kind of material that does not absorb anesthetic gases (such as laughing gas), thereby the capsule pressure inside can not raise during use.

In any alternative embodiment, capsule can be made by a kind of material that is suitable for absorbing liquid (such as water, mucus or blood or similar liquid substance), absorption has caused the expansion of capsule size, thereby the anatomical tissue structure of itself and patient's atrium of larynx mucosa cartilage (mucocartilagenous) is suitable.These materials will be selected by the material expert, comprise CRM (cotton and staple fibre blending), such as TAMPAX (registrar entitling) tampon or compress among the Gel Foam5 (gluey foam) use.

In another alternative embodiment, capsule will adopt a kind of traditional expandable form.Although so do no all roses, reason is the inherent unfavorable aspect of expansion type capsule itself, but buccal space fixture type, that made by aforesaid flexible material is attached to an inflatable throat bell-type breather when comparing with the expansion type cover tool of prior art as mentioned above, has still represented tangible progress.The technology of making the expansion type capsule is well-known, need not in this description.

Generally speaking, target of the present invention is fitted with anatomical structure for providing a kind of mutually with purpose, reliable, simple and low-cost apparatus, described device is used for the acceptance anesthesia patient of autonomous respiration or the patient who recovers from narcotism, and some is in the Intensive Care Therapy patient during isolation processes (weaning process) or the recovery, with the delivering oxygen that a safety, cleaning, non-hand-held are provided and/or the breather of anesthetic gases.

Main target and purpose are as follows:

■ provides an easy device, all advantages with existing breather, and have the working mechanism suitable mutually with anatomical structure, to obtain a kind of breather of cleaning, be used in some the Intensive Care Therapy patient who is in the patient in recovery stage behind the acceptance anesthesia patient, anesthesia of autonomous respiration or is in (weaning off ventilatory support) under the isolated instances of not having ventilation.

■ has eliminated all drawbacks and the complexity of the breather that is used for anesthesia procedure at present.

■ need not to carry out laryngoscopy, intubate or tube drawing, and minimally invades the throat.

■ belongs to user friendly type, only needs anaesthetist, other doctors, nurse, paramedic and may use other health workers of this device to carry out minimum training.

■ useful instrument is used in and expects outer or/and in the operation of pre-interim difficult endotracheal intubation.It helps endotracheal tube is penetrated breather, and helps regular fiber cannula or bronchoscopy.

But self fixes ■, needs gluing hardly or ties.

Generally speaking, this device has a connector, outstanding glossopharyngeum throat position flange, and be pre-charged with, according to the throat's cup or the capsule of anatomical structure design, definite profile and the shape in described throat cup or capsule and atrium of larynx position is suitable.Yet this is not that the present invention can not together use with traditional expansion type capsule.

The ■ connector:

The ISO of 15mm (International Standards Organization) connector, be suitable between postanesthetic convalescent period,

In Intensive Care Therapy and recovery process, be connected with any gas delivery system as anesthesia.

Glossopharyngeum position/buccal flange that ■ is outstanding:

All existing vented cannula devices all have the probability that shifts out to oral cavity right corner or left comer sidesway, around its longitudinal axis Rotate 180 degree and airway shift-in to some extent, this can cause the displacement or the dislocation of its distal portion in the use of breather, and then makes described breather not have effect.The combination of the outstanding flange on the described device and described device are made less than 60 material by Shore A hardness, this two aspect has guaranteed that the buccal space fixture can play the effect of anchor of a midline position of breather, described fixture by open and flat in the buccal space on the tongue anterior face, and, thereby breather is anchored on the lingual surface better by inner face (inner surface) lateral support.Thereby, not only stabilize breather to the center, and make breather stop sidesway and/or rotation.At far-end, outstanding flange is connected with throat cup position flat, the one-tenth certain taper, i.e. the back lower surface place at this device tubulose position is to provide further grappling effect at the narrow hypopharynx of far-end.

Throat's cup that ■ is suitable mutually with anatomical structure:

A kind ofly make by soft rubber, or molding in advance, the suitable fluid or the cup of flexible material in advance expand/are pre-charged with, purpose is not for applying chamber pressure greater than the 22mm mercury column to the mucosa at atrium of larynx position and adjacent tissue's structure, thereby avoid compressive stress and shearing stress to put on the pharyngolaryngeal mucosa, and then guarantee one continuously, the surrounding tissue of flowing through blood flow capillaceous, guaranteed smooth and easy with the blood supply of described device contacting structure further.With the suitable mutually cup sealing of anatomical structure surround atrium of larynx, and can not make the torsional deformation of organizing that is in contact with it.

On the side, the outside ledge of cup or capsule is designed to the recess of Wood-scoop epiglottis pleat suitable with the pears shape nest place down.Tapered bottom makes it be easy to be inserted into oral cavity and pharyngeal, its will be positioned at pleat between the arytenoid cartilage of center line (interytenoidfold) and be positioned at the cuneiform cartilage of side and corniculate cartilage on form sealing.A crack that is positioned at the top midline position will help cup to be inserted on the epiglottis, not be folded and will be screwed in the vestibule or distal openings on the described cup-formed device and can not be damaged to epiglottis or epiglottis.Fissured top is the more flat part of softish cup, and it is designed to be positioned over best the hypopharynx between epiglottis and the tongue bottom, thereby on every side tissue and glottis are separated.Although cup provides an intimate nature and the sealing suitable mutually with anatomical structure on the opening of glottis, but can not guarantee to prevent the suction of the anti-gastric content that flows.This risk can be reduced to minimum by use the modifying device with esophagus parts on the high risk patient.

The ■ size:

Size can be from No. 0 to No. 7.

No. 1 to No. 2: neonate and child (body weight 3 to 20kgs)

No. 3: child's (body weight 21 to 50kgs)

No. 4 to No. 5: teenager (body weight 51 to 90kgs)

No. 6 to No. 7: adult (body weight is greater than 90kgs)

Preferably, reusable device or disposable apparatus are made by aforesaid material, such as SEBS that does not contain latex or medical grade silicone.The device of reusable (can sterilize) can use 40 times at least.The simple of design makes that also the sterilization of reusing device becomes simple and easy.Disposable apparatus is a kind of preferred product, and it is not only more economical, and without any the possibility as the cross infection of meeting generation in reusable device.

From aforesaid design feature, may well be all lower according to device of the present invention than the cost of any comparable device.

■ has the NLA of esophagus parts:

Additional esophagus parts will be used on one's body the patient that stomach symptom (gastricstatis) may take place anestheticing period, the patient who also is used for intensive care unit airway hyperirritability, described patient all exists owing to isolate the problem that cause the back with ventilation, and these problems are extensively admitted and are widely known by the people.Almost for certain, this class patient finally need carry out tracheotomy, walking around its upper airway hypersensitive, thereby is convenient to isolate.The patient who suffers from chronic obstructive/restrictive respiration disease, asthma and severe smoking is more likely taken place by the problem of isolating initiation.

■ cannula type NLA

Or/and invalid situation or the mortality rate of the patient who has difficult intubation outside expecting are generally acknowledged aspects for anesthesia procedure, then a challenging difficult problem for any anaesthetist who faces this kind situation in the expectation.Under the help of bougie, Cook ' s airway or optical fiber sight glass, the modified model of NLA (longitudinal crack that promptly has a molding in advance in the front portion of NLA) will be easy to make endotracheal tube pass NLA and carry out intubate.

■ other:

For shape, design and the working mechanism of each parts of NLA, should be able to be susceptible to some and change, no matter these variations are based on the needs of NLA improvement in performance, also be based on the needs of its good looking appearance aspect.

Whole breather can be made one, but under the situation about needing based on the consideration of the improvement of its function or cost aspect or owing to any other practical problem, also can make each parts earlier respectively.

Fig. 1 index

??1a	Epiglottis (Epiglottis)
		??1b	Hyoid bone (Hyoid Bone)
??1c	Thyrohyoid membrane (Thyrohyroi dmembrane)
		??1d	Corniculate cartilage (Corniculate cartilage)
??1e	Thyroid cartilage (Thyroid cartilage/Adam sapple)
		??1f	Arytenoid cartilage (Aryteniod cartilage)

??1g	Cricothyroid ligament (Cricothyroid ligament)
		??1h	Cricoid cartilage (Cricoid cartilage)
??1i	Cricotracheal ligament (Cricotracheal ligament)
		??1k	Thyroid (Thyroid gland)
??1m	Parathyroid gland (Parathyroid glands)
		??1n	Trachea (Trachea)
??1o	Tracheal cartilages (Tracheal cartilage)
		??1p	Epiglottis (Epiglottis)
??1q	Hyoid bone (Hyoid Bone)
		??1r	Thyrohyoid membrane (Thyrohyroid membrane)
??1s	Thyrohyoid membrane (Thyrohyroid membrane)
		??1t	Cuneiform cartilage (Cuneiform cartilage)
??1u	Fat-body (Fat Body)
		??1w	Corniculate cartilage (Corniculate cartilage)
??1x	Sound chamber's folds in a garment/false vocal cord (Ventricular Fold/false vocal chord)
		??1y	Arytenoid cartilage (Aryteniod cartilage)
??1z	Thyroid cartilage (Thyroid cartilage)
		??2a	Vocal cords/true vocal cord (Vocal Fold/true vocal chord)
??2b	Cricoid cartilage (Cricoid cartilage
		??2c	Cricothyroid ligament (Cricothyroid ligament)
??2d	Tracheal cartilages (Tracheal cartilage)
		??2e	Cricotracheal ligament (Cricotracheal ligament)

Claims (36)

1. breather that is used for the human and animal, described breather comprises an airway with a distal portion and a close end, the distal portion of described airway is around a laryngeal cuff, described laryngeal cuff is suitable for forming connecting airtight of an anatomical fit at patient's atrium of larynx position, it is characterized in that described device further comprises a buccal space fixture, above the airway of described buccal space fixture between laryngeal cuff and catheter proximal end portion or on every side, and described buccal fixture is suitable for patient's tongue front portion suitable, its size, shape, pliability and profile are suitable for providing stability and can prevent airway rotation or shifted laterally in use.

2. according to the described breather of claim 1, wherein capsule is unexpansive formula, and makes a shape in advance, and described shape is suitable for forming connecting airtight of anatomical fit feature on patient's atrium of larynx position.

3. the breather of stating according to each aforementioned claim, wherein said throat annular overlap in advance inflation or are pre-charged with suitable fluid.

4. according to the described breather of each aforementioned claim, wherein be suitable on patient's atrium of larynx position forming the face of the laryngeal cuff of connecting airtight of an anatomical fit feature, have and be designed to the bellying that can form excellent sealing with pears shape nest place in patient's atrium of larynx position and Wood-scoop epiglottis pleat.

5. according to the described breather of claim 4, wherein be suitable on patient's atrium of larynx position, forming the face of the laryngeal cuff of connecting airtight of an anatomical fit feature, have and be designed to and form excellent sealing with Sublingual small stream portion (Sublingual ditch, epiglottic vallecula valleculae), epiglottis, Wood-scoop epiglottis pleat, pears shape nest place, and can form the bellying of excellent sealing around the front portion of first shape and cricoid cartilage.

6. according to the described breather of each aforementioned claim, wherein be suitable on patient's atrium of larynx position, forming the face of the laryngeal cuff of connecting airtight of an anatomical fit feature, have groove, described groove design becomes can guarantee to supply the important tremulous pulse, vein of laryngeal structure and neural unobstructed.

7. according to the described breather of each aforementioned claim, the far away vertical size and dimension of wherein said throat cup be suitable in use making its remain on sphincter of gullet above.

8. according to the described breather of claim 7, the far away vertical spill substantially that is shaped as of wherein said throat cup.

9. each breather of stating in the claim 1 to 3 (containing), wherein said throat cup is made by a kind of material that is suitable for absorbing liquid in advance, described flowing fluid ratio such as water/mucus/blood or similar substance, thereby cause that described throat cup expands, and then suitable with the anatomical structure of atrium of larynx mucosa cartilage, described material for example is used for making the CRM (cotton and staple fibre blending) of TAMPAX (registrar entitling) tampon or compression Gel Foam 5 (gluey foams).

10. according to the described breather of each aforementioned claim, wherein said buccal space fixture has one first, is the outside of belly, its substantially with the opening surface of the laryngeal cuff plane that exists together, and first of described buccal space fixture be shaped as spill substantially.

11. according to the described breather of each aforementioned claim, the close end of wherein said buccal space fixture from the close end of laryngeal cuff towards airway extends the structure thereby capsule and buccal space fixture become one.

12. according to the described breather of each aforementioned claim, the width W of wherein said buccal space fixture is inconsistent, has a width point among the close end of laryngeal cuff and airway.

13. as the breather of in claim 12, being stated, the close end of close more laryngeal cuff of the width point of wherein said buccal space fixture rather than close more airway.

14. as the breather in each aforementioned claim, stated, the width W of wherein said buccal space fixture is 2.7 ± 10% at the ratio of its wideest some place and the height H of the buccal space fixture that is in same point.

15. as the breather of being stated in each aforementioned claim, the face that wherein said buccal space fixture contacts with patient's tongue is a matsurface, with the friction of increase in use with tongue.

16. according to the described breather of each aforementioned claim, the size adjustable of wherein said buccal space fixture is whole.

17. according to the described breather of each aforementioned claim, wherein said buccal space fixture is made parts, the form that described parts at least a portion can be slided is contained on the airway.

18. as the breather of being stated in each aforementioned claim, wherein said buccal space fixture is made the part of the whole of airway.

19. according to the described breather of each aforementioned claim, wherein said buccal space fixture, airway and laryngeal cuff are made one.

20. according to the described breather of each aforementioned claim, wherein said laryngeal cuff is equal to or less than 40 material by Shore A hardness and makes.

21. according to the described breather of claim 20, wherein said laryngeal cuff is made by the material of Shore A hardness 0 to 20.

22. according to the described breather of claim 21, wherein said laryngeal cuff is made by the material of Shore A hardness 4 to 12.

23. according to the described breather of each aforementioned claim, the forward part of wherein said laryngeal cuff and buccal space fixture, be outside of belly part by Shore hardness substantially identical materials make.

24. according to the described breather of each aforementioned claim, the back part of wherein said device or be back part and the forepiece of described device or make outside of belly parts make by the different material of Shore hardness.

25. according to the described breather of claim 24, wherein said back part or back part are made less than 60 material by Shore A hardness.

26. according to the described breather of claim 25, wherein said back part/back part is made by the material of Shore A hardness 25 to 45, is preferably between 30 to 40.

27. according to claim 1 and each described breather in 4 to 26 (containing), wherein said laryngeal cuff is an expansion type.

28. according to the described breather of each aforementioned claim, wherein said device further comprises a gastric tube passageway, it extends to the close end of described device from the outstanding top of capsule.

29. a breather described herein substantially, described description is illustrated by arbitrary in 2 to 18 (containing) with reference to the accompanying drawings.

30. a method of making breather comprises following steps:

(a) make first parts of described device and the moulded parts of second parts;

(b) by connector first parts and second parts are connected together.

31. according to the described method of claim 30, the forepiece that wherein said first parts are device, be outside of belly parts, it includes the face of laryngeal cuff, and described second parts are back part, are back part.

32. according to claim 30 or 31 described methods, wherein said first and second parts are made by the different material of Shore hardness.

33. a manufacturing includes the method for the breather of fixture between an airway, laryngeal cuff and cheek, described method comprises the plastic mould that described device is formed one.

34. as the manufacture method of being stated in claim 33, wherein said device is made with injection molding method.

35. according to each described manufacture method in the claim 30 to 34, wherein said manufacture method is applied on the manufacture method according to the described device of claim 1 to 29.

36. manufacture method described herein substantially.

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